Provider First Line Business Practice Location Address:
114 S MOUNTAIN AVE
Provider Second Line Business Practice Location Address:
WHITE MOUNTAIN SPECIALTY CLINIC
Provider Business Practice Location Address City Name:
SPRINGERVILLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85938-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-468-3132
Provider Business Practice Location Address Fax Number:
888-717-3257
Provider Enumeration Date:
06/11/2009